Total Elbow Replacement (TER)
Total elbow replacement (TER) in dogs is in its infancy. Hip replacements have been performed in dogs for many years but the first commercial elbow system, the Iowa State elbow, was only released in 2004. The Iowa State system was not without its problems however and although dogs with severe elbow pain were generally much more comfortable after surgery, complications were not uncommon. The TATE (Total Arthroplasty of The Elbow) system has been developed to avoid some of the problems of the previous system.
The novel feature of the TATE system is that the amount of bone and cartilage removed from the joint is minimised and the artificial joint surfaces are implanted as a press-fit cartridge. As this is a relatively new system there is not long-term follow-up on 1000’s of cases. TER is a complex surgery and as such complications can occur. Reported complications rates are in the region of 15% within the first 3-12 months. However, a successful outcome has been reported in around 75% of cases with owners reporting significant decreases in pain severity and pain interference with daily activities.
Few centres in the UK can claim to have the experience of elbow replacement that we have at Anderson Moores. James is one of the few UK surgeons who is certified to implant and has clinical experience of using the TATE elbow system, both whilst he was working at the Royal Veterinary College and also here at Anderson Moores Veterinary Specialists.
So what cases are suitable for TER?
TER is reserved for medium-large breed dogs with significant and persistent clinical signs attributable to elbow disease, most commonly elbow dysplasia/osteoarthritis. Currently TER is only considered for patients where all other management options have failed to improve function and quality of life.
Total elbow replacement is not appropriate for all dogs with elbow disease. Prior to surgery all patients are assessed clinically and further imaging such as CT scans and arthroscopy are often performed to assess suitability for surgery. Long term management options, costs and the risks of surgery are always discussed with the owner in detail prior to committing to elbow replacement.